ACS Advocacy Brief: July 13, 2023

ACS Responds to Congressional Hearing on MACRA Implementation

In June, the US House Energy and Commerce Oversight and Investigations Subcommittee held a hearing, “MACRA [Medicare Access and CHIP Reauthorization Act] Checkup: Assessing Implementation and Challenges that Remain for Patients and Doctors.” In response to the hearing, the ACS submitted a statement for the record, which outlines some of the recent work the ACS has undertaken to improve surgical quality and value and provides steps Congress can take to improve the current system.

The statement was submitted into the record during the hearing by Rep. John Joyce, MD (R-PA), along with a joint statement signed by 20 organizations representing surgeons and anesthesiologists that highlights immediate steps Congress and the Administration can take to bring stability to the payment system.

The ACS continues its long-standing support for providing an inflationary update mechanism to the conversion factor in the Medicare Physician Fee Schedule (MPFS). Addressing inflation is a key component of stabilizing the Medicare physician payment system. Additionally, it is critical that Congress stop pending payment cuts, including any cuts emerging from the Calendar Year 2024 MPFS rule. The proposed rule is expected to be released soon.

The ACS is dedicated to partnering with Congress on long-term reform of the Medicare payment system to ensure surgeons can deliver high-quality, cost-effective care. 

Congressional Champions Pen Letter to Leadership on Medicare Payment Reform—Encourage Your Representative to Join

Representatives Ami Bera, MD (D-CA), and Larry Bucshon, MD (R-IN), are leading a sign-on letter in the US House of Representatives urging leadership to work together to address the broken Medicare payment system by ensuring its long-term stability and adequately incentivizing high-quality care.

MACRA was intended to solve the problem of the failed sustainable growth rate formula by eliminating annual mandated cuts not tied to the value of care provided, while simultaneously creating incentives for the delivery of higher-value care. Unfortunately, MACRA has fallen short of effectively achieving either of these goals, and as a result, many physicians remain locked into a budget-neutral fee-for-service system that results in frequent, steep cuts and still fails to incentivize quality or value. Specifically, the letter calls for urgently enacting MACRA reforms and establishing a stable payment mechanism.

Contact your US House Representative using ACS SurgeonsVoice and ask them to sign this critical letter before the Wednesday, July 27 deadline.

Lawmakers Reintroduce Bill to Strengthen Palliative and Hospice Care Workforce

Senators Tammy Baldwin (D-WI) and Shelley Moore Capito (R-WV) recently reintroduced the Palliative Care and Hospice Education and Training Act, aimed at bolstering the palliative and hospice care workforce.

The bill would improve the training of health professionals in palliative care by creating Palliative Care and Hospice Education Programs to provide short-term intensive courses focused on palliative care and establish traineeships for individuals working to become nurses, social workers, or physician assistants who focus their studies in palliative care. Additionally, the legislation expands palliative care research to strengthen clinical practice and improve care delivery for patients with serious or life-threatening illnesses.

Palliative care plays an important role in improving the quality of life for many patients. This legislation is a noteworthy first step to ensuring that providers are appropriately and adequately trained to deliver relief of the symptoms and stress of a serious illness and implement high-level care coordination.

The ACS joined a stakeholder letter in support of the legislation.

House Committee Holds Hearing on PAHPA Reauthorization

The US House Committee on Energy and Commerce recently held a hearing as part of the ongoing effort to reauthorize the Pandemic and All-Hazards Preparedness Act (PAHPA). The hearing examined the framework for the legislation, and Committee members heard testimony from witnesses representing a wide range of stakeholders.

The ACS has engaged with the Committee about the importance of establishing a National Trauma and Emergency Preparedness System (NTEPS) and other legislative priorities, such as the reauthorization of the MISSION ZERO Act. In advance of the hearing, the ACS sent a letter to Committee leadership urging the transition from planning for catastrophic events to managing day-to-day coordination of care and establishing an NTEPS within the Administration for Strategic Preparedness and Response.

The ACS will continue efforts to have Congress reauthorize PAHPA.

ACS Urges Update to Healthcare Preparedness Guidance

The Administration for Strategic Preparedness and Response (ASPR), formerly the Office of the Assistant Secretary for Preparedness and Readiness, has begun the process of updating its Health Care Preparedness and Response Capabilities guidance. The document describes what the healthcare delivery system, including healthcare coalitions, hospitals, and emergency medical services, must do to effectively prepare for and respond to emergencies that impact public health. Each jurisdiction, including emergency management organizations and public health agencies, provides key support to the healthcare delivery system.

The ACS sent a letter to ASPR staff, thanking them for their thoughtful approach in integrating Regional Medical Operations Coordination Centers as part of the guidance and suggesting that ASPR consider the importance of daily coordination as part of the update.

The ACS has stressed the critical importance of incorporating the lessons learned from the pandemic into a robust, inclusive, and coordinated infrastructure to strengthen preparedness and response for future mass population events.

Lawmakers Press CMS to Reform Prior Authorization in Medicare Advantage

A bipartisan group of 233 Representatives and 61 Senators in June sent letters to the US Department of Health and Human Services and the Centers for Medicare & Medicaid Services (CMS) urging CMS to strengthen and finalize rules that would improve prior authorization (PA) processes under Medicare Advantage.

The letters, which were led by Representatives Suzan DelBene (D-WA), Mike Kelly (R-PA), Ami Bera, MD (D-CA), and Larry Bucshon, MD (R-IN), and Senators Sherrod Brown (D-OH), John Thune (R-SD), Kyrsten Sinema (I-AZ), and Roger Marshall, MD (R-KS), call on CMS to expand on the proposed rules by establishing a mechanism for real-time electronic PA decisions for routinely approved items and services; requiring that plans respond to PA requests within 24 hours for urgently needed care; and requiring detailed transparency metrics related to delays, denials, and appeals.

The strong bipartisan support was due, in part, to ACS Fellows reaching out to their elected officials through SurgeonsVoice and urging them to support the letter. The ACS will continue to engage with Congress and the Administration on reforming the prior authorization process to ensure timely access to care for patients.

ACS Supports Funding for Neglected Surgical Conditions in Developing Countries

The ACS in June led an organization sign-on letter to US House of Representatives and Senate Appropriators requesting the inclusion of $10 million for Neglected Surgical Conditions within the State, Foreign Operations, and Related Programs (SFOPS) Appropriations Report for Fiscal Year (FY) 2024.

The ACS successfully supported previous work to include language recognizing the importance of strengthening capacity to address neglected surgical conditions in low-resource countries in the FY 2021 and FY 2022 SFOPS Report.

The $10 million in funding would strengthen surgical capacity to address health issues including cleft lip and cleft palate, club foot, cataracts, hernias, fistulas, and untreated traumatic injuries in underserved areas in developing countries. Strengthening surgical health systems includes the training of local surgical teams to provide safe, sustainable, and timely surgical care, and assisting ministries of health to develop and implement national surgical, obstetric, trauma, and anesthesia plans.

Last Chance to Register for August In-Person ACS Coding Course in Nashville Is Approaching

The next in-person ACS/Karen Zupko & Associates (KZA) Current Procedural Terminology (CPT) coding course is coming up soon, August 3–4, in Nashville, Tennessee.

August 3-4
Loews Vanderbilt Hotel, 2100 West End Avenue, Nashville, TN
Reservation Phone: 877-879-7818
Register today!

With Medicare and third-party payer policy and coding changes taking effect in 2023—some with significant potential reductions in payment for surgeons—it is imperative that surgeons and their coding staff have accurate and up-to-date information to protect reimbursements while optimizing efficiency. 

The course includes sessions on hospital evaluation and management (E/M) and critical care coding, Thursday, August 3, 1:00–5:00 pm, and general surgery coding, Friday, August 4, 8:00 am–4:00 pm.

Session #1: Reporting Hospital E/M Codes and Split/Shared and Critical Care Services Course

Topics covered will include E/M codes for inpatient/facility, major changes in CPT code selection, and major changes to Medicare’s billing rules for both split/shared services and critical care.

Session #2: General Surgery: Revenue and RVU Optimization Course

Topics covered will include the revamped abdominal hernia codes (e.g., the use of the same CPT codes for both laparoscopic and open procedures, and basing codes on the total size of the hernia). In addition, this session will cover coding for endoscopy, colorectal, and breast, among other procedures. 

ACS members and their staff receive a registration discount. For issues with registration, email KZA at education@karenzupko.com, or call 312-642-8310.

For more information or questions about the 2023 ACS live coding workshops, visit the KZA website, or send an email to practicemanagement@facs.org.